When the nine year-old American Quarter Horse Graceful Leaguer, known around the barn as Grace, had to enter rehabilitation after first-of-its-kind surgery on a deeply fractured shoulder, it was The Sanctuary Equine Sports Therapy and Rehabilitation Center that her surgeon, UF College of Veterinary Medicine’s Sarah Graham, D.V.M., trusted with the recovery.

“We understood that this was an unusual and rather extreme surgery. It’s not something that happens often and the prognosis has never been good,” said Brenda McDuffee, general manager for The Sanctuary Equine Sports Therapy and Rehabilitation Center in Ocala, Florida. The Sanctuary, lead surgeon Sarah Graham, DVM, and head veterinarian, Peter Kazakevicius, DVM, collaborated to participate in the recovery of the Jacksonville “miracle horse.”

“That Gracie is even alive is something of a miracle, given the medical challenges of her condition,” explained Dr. Graham, a clinical assistant professor in the UF College of Veterinary Medicine’s department of large animal sciences and lead surgeon on the case. “But the willingness of a local rehabilitation center to provide regular physical therapy to aid in her healing adds a special, well, saving grace to her story.”

Unable to bear weight on her right foreleg, the mare was brought to UF as an emergency patient in November 2012. Andrew Smith, D.V.M., a large animal surgery resident on duty that night said, “She was in a lot of pain and distress.” A bone scan revealed a rare fracture to her humerus in an area known as the lesser tubercle.

“There is no report in literature of this type of fracture being fixed,” Dr. Graham said. “The fracture itself is very rare.” Surgical access, deep inside the mare’s shoulder, would be daunting.

“Routine fracture repair involves bone screws and plates, but that was not possible in Gracie’s case due to the location of the fracture. The piece of bone that was fractured is an insertion point for a number of muscles that stabilize the shoulder,” she explained, Muscles would pull constantly on the bone, making healing nearly impossible.

The greatest asset to the case proved to be Gracie. UF surgeons saw her calm temperament, willingness to let them help her, and good instinct for taking care of herself. “Those characteristics,” said Dr. Graham, “plus her owner’s attachment to her, were encouraging.”

Drs. Graham and Smith performed the hours-long procedure as they entered new surgical territory: Rather than try to repair traditionally irreparable bone, they simply removed the fractured piece entirely.

The first few weeks after surgery went smoothly and Gracie went home to begin recuperative stall rest and limited exercise. But when she returned to UF several months later for reexamination, her care team noted severe lameness. Gracie had developed heavy scarring that was restricting motion throughout her shoulder joint.

What was needed, UF veterinarians agreed, was more physical therapy to maximize her recovery. Therapy with access to the sophisticated modalities that only a rehabilitative center dedicated to equine athletes could offer.

“We really felt that this case was unique and needed to be written up for scientific publication,” Graham said. “But more importantly, we wanted to give Gracie the best possible outcome.”

So Dr. Graham contacted Dr. Kazakevicius at The Sanctuary, who welcomed the chance to contribute its expertise in rehabilitation to this historic case in equine medicine.

“We hoped to show that proper rehabilitation could make a huge difference in the horse’s overall health,” added McDuffee. “We started in July with hydrotherapy in a water treadmill to increase buoyancy and offset her weight.” She also received laser, vibration and magnetic pulse therapies to relax muscles and counter body soreness.

On November 24, 2013, almost a year to the day since UF veterinarians performed the first surgical removal of a lesser tubercle from her shoulder, The Sanctuary discharged Gracie to her owner, having rebuilt her strength through a combined prescription of play and rehabilitative exercise.

Dr. Graham knows the rehabilitation Gracie received at The Sanctuary allowed her to return to a four-legged life. While she may never go back to full-time riding, she should be healthy enough to live comfortably in a pasture: “Now she has increased range of motion, increased weight bearing and her whole body condition has vastly improved. She looks healthier and happier. It’s definitely thanks to a team effort.”

McDuffee said, “The Sanctuary is proud of the success it has earned over the years helping to rehab horses. Just like human athletes, our horses deserve our teamwork to keep them in the best condition they can be.”

Read more inspiring stories of recovery and learn more about the range of services offered at The Sanctuary by visiting www.sanctuaryequinerehab.com.

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